Nursing homes undertreat dementia patients' pain

01 may 2008--Nursing home residents with dementia appear to be less likely to receive pain medication than other residents, even though they have just as many painful health conditions, a new study suggests.
Researchers at the University of North Carolina Chapel Hill evaluated data for 551 residents of six nursing homes across the state and found that residents who were cognitively impaired were less likely to receive regular doses of pain medication or to receive pain drugs at all.
This was despite the fact that dementia patients and cognitively healthy patients had similar rates of often-painful conditions like cancer, osteoarthritis and degeneration in the spinal disks.
Pain medications are often prescribed to be taken "as needed," the researchers note. The findings suggest that more nursing home residents with dementia should be on regularly scheduled doses of pain medication, they report in the Journal of Pain and Symptom Management.
This does not mean that undertreatment stems from neglect on the part of nursing home staff, lead author Dr. Kimberly S. Reynolds and her colleagues point out in the report. Instead, it is simply more difficult to recognize pain in dementia patients, who often lack the ability to communicate their symptoms or ask for pain drugs, as cognitively healthy nursing home residents do.
Indeed, the researchers' review of residents' medical records showed that while 34 percent of those with no cognitive impairment had documented pain in the past week, this was true of only 10 percent of residents with the most severe cognitive impairment.
Severely impaired patients were also more likely to have their pain documented as "less than daily" and "mild."
It was not surprising, then, that residents with dementia received pain drugs less often, according to Reynolds' team. Overall, 80 percent of residents with no impairment received pain medication at least occasionally, versus 56 percent of those who were the most severely impaired.
Similarly, 42 percent of cognitively healthy residents were on regularly scheduled doses of pain relievers, compared with only 23 percent of residents with severe dementia.
Yet it is unlikely that dementia patients truly were in less pain than their cognitively healthy counterparts, Reynolds and her colleagues write. In both groups of patients, roughly half had medical conditions likely to cause pain.
Given that severely impaired patients may be unable to complain of pain or ask for medication, the researchers conclude, in many cases it would be "more appropriate" for them to be on scheduled doses of medication.
SOURCE: Journal of Pain and Symptom Management, April 2008.